Page 91 - Livre électronique des Rencontres Franco-Tunisiennes de Pneumologie 2019

P54. TUBERCULOSIS OCCURRING IN ADULT IDIOPATHIC PULMONARY HEMOSIDEROSIS

MOUNA GUERMAZI, NESRINE REGAÏEG, SOUAD YAHYAOUI, SALEM BOUOMRANI

SERVICE DE MEDECINE INTERNE, HOPITAL MILITAIRE DE GABES 6000-TUNISIE

Introduction: Idiopathic Pulmonary Hemosiderosis (PIH) is an exceptional chronic respiratory
disorder of unknown etiology. Its prevalence is estimated at 0.24 to 1.23 cases per million and
nearly 80% of the cases manifest before the age of 10. Adult forms are very rare. We describe
here the case of pulmonary tuberculosis occurring in adult patient with IPH.
Case report: A 20-year-old woman was explored of recurrent hemoptysis, stage II dyspnea and
chronic caught. Laboratory tests showed a microcytic and hypochromic hyposideremic anemia
without other anomalies. X-rays and chest CT scans showed bilateral and diffuse alveolar-
interstitial syndrome. Bronchoalveolar lavage was suggesting of intra alveolar hemorrhage.
Systemic disease, vasculitis and severe infections were excluded and the diagnosis of IPH was
confirmed by lung biopsy revealing hemosiderin-laden macrophages in the alveoli. Patient
received systemic glucocorticoids with a good and total response. Eight months later she was
admitted because of fever, hemoptysis, marked inflammatory syndrome and leucopenia. Chest
radiography and tomography were no contributive. Bronchofiberoscopy with direct exam for
mycobacterium tuberculosis was positive. Under anti-tubercular therapy the evolution was
favorable
Conclusion: Lung tuberculosis associated to idiopathic pulmonary hemosiderosis is very rare.
Immunodeficiency, corticotherapy as well as the subjacent pulmonary lesions can support such
an association.

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